Effectiveness of “Discharge Guidance Programme” on medication compliance and complications among patients undergone heart valve replacement.

Abstract

Background: In India, rheumatic heart disease (RHD) affects approximately 5 to 7 out of every 1,000 children aged between 5 and 15 years, with an estimated 1 million individuals living with the condition, with many patients needing valve replacement surgery. While surgery is crucial, effective post-operative counseling and adherence to lifelong oral anticoagulant therapy (OAT) are vital to prevent complications such as thromboembolism or bleeding. Despite the clear need, there's a notable lack of formal research in India assessing how effective counseling truly impacts patient adherence and long-term outcomes after valve replacement.

Methods: A  Quasi experimental research  study was conducted from December 2024 to Feb 2025 , using a total enumeration method. A structured questionnaire was developed, validated, and administered to 54 patients.

Results: This comparative study involving 54 heart valve replacement patients (experimental group n=27, control group n=27) at KGMU, Lucknow, assessed the effectiveness of a Discharge Guidance Programme on medication adherence and post-operative complications. Baseline demographic and clinical characteristics were comparable between groups (all p > 0.05). Kolmogorov-Smirnov test confirmed non-normal distribution of outcome variables (all p < 0.05), leading to the use of non-parametric tests. At baseline, medication adherence was similar between groups (Chi-square p = 0.362; Mann-Whitney U p = 0.517). However, the Discharge Guidance Programme significantly improved medication adherence in the experimental group. At 1st week post-discharge, 70.37% of the experimental group demonstrated high adherence compared to 18.51% in the control group (p = 0.001), with a significantly higher mean adherence score (experimental: 8.00 ± 0.00; control: 2.79 ± 1.24; p = 0.000). This improvement was sustained at 4th week post-discharge, with 88.88% high adherence in the experimental group vs. 51.85% in the control group (p = 0.006), and significantly higher mean adherence (experimental: 8.00 ± 0.00; control: 3.02 ± 1.27; p = 0.000). The program also significantly reduced post-operative complications. At 1st week post-discharge, the experimental group had a lower incidence of complications (7.40%) compared to the control group (44.4%), with a significantly lower mean complication score (experimental: 0.22 ± 0.51; control: 1.00 ± 1.24; p = 0.01). By 4th week post-discharge, no patients in the experimental group reported complications (0%) compared to 29.6% in the control group, maintaining a significantly lower mean complication score (experimental: 0.00 ± 0.00; control: 0.29 ± 0.608; p = 0.01). Significant positive correlations were found between 1st and 4th week scores for complications (r=0.377, p=0.005) and medication adherence (r=0.311, p=0.022). 

Conclusion: The findings of this study demonstrate that the "Discharge Guidance Programme" is an effective intervention for improving medication adherence and reducing the incidence of post-operative complications among patients who have undergone heart valve replacement. The experimental group, which received the guidance programme, exhibited significantly better medication compliance and experienced fewer complications in the crucial 4-week period following discharge compared to the control group receiving standard care. This suggests that a structured discharge guidance programme can play a vital role in enhancing patient outcomes and potentially reducing the burden of post-surgical morbidity.